Provider Demographics
NPI:1801838792
Name:GREEN, DENNIS N (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:N
Last Name:GREEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8733 S PAULETTES PL
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-7409
Mailing Address - Country:US
Mailing Address - Phone:228-523-5103
Mailing Address - Fax:228-523-4510
Practice Address - Street 1:400 VETERANS AVE
Practice Address - Street 2:BLDG 1 160
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:228-523-5103
Practice Address - Fax:228-523-4510
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0098741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice